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Swat those classroom bugs

Some chronic children's illnesses are on the increase. Jill Wyatt offers a portrait of the ailments you could encounter

Children's health has improved significantly over the past few decades in line with the rest of the population in this country. But the news isn't all cheery: chronic conditions, such as diabetes, are on the increase and there are concerns that old enemies of childhood could be staging a comeback.

Your experience of children's health problems, endless sniffing and coughing aside, will probably vary according to where you teach, since poverty and nationality - and possibly even geography - play roles of varying importance in the incidence of certain diseases. Sickle cell anaemia, for example, is an inherited disease of malarial tropical areas: between and 1 and 4 per cent of all babies born in East and West Africa suffer from it. It is also common in central India.

Migration of these populations has resulted in the disease occurring with increasing frequency in other areas of the world. In the UK, more than 3,500 babies born every year will carry the sickle-cell gene; an estimated 200 will develop the disease.

Asthma is also more common among African-Caribbean children than in any other ethnic group. But since it is rife among all nationalities - there are 1.4 million children in this country (1 in 8) diagnosed with the condition - encountering it is inevitable.

In the past 30 years, there has been a six-fold increase in the numbers diagnosed. According to a recent survey, the UK has the "highest incidence of wheeze" (a key symptom) in the world.

Asthma is a complex condition, with both environmental and genetic factors influencing the likelihood of a child developing it. Air pollution does not appear to be a factor, but damp housing, an unhealthy diet and maternal smoking have all been implicated, so in some cases it is possible to make a loose link with deprivation.

Contrary to popular belief, geography is not a factor in how commonly the condition occurs. "It doesn't matter if a child lives in an urban or rural environment," says a spokesperson for the National Asthma Association.

"Figures for asthma are the same in the Isle of Skye as in the City of Birmingham."

Few diseases affecting children can to be linked directly to location, although there has been extensive research into a possible connection between leukaemia clusters and nuclear plants.

One big British study examined anecdotal reports that cancer rates were excessively high for children who lived near the Sellafield plutonium re-processing plant. The study concluded that the chances of children suffering from it were increased by six to eightfold for those whose fathers worked at Sellafield. But other worldwide research has come up with contradictory findings.

Similarly, research into possible links between leukaemia clusters and electromagnetic fields, pollution or proximity to waste tips has proved inconclusive.

While an explanation for a rise in Type 1 diabetes among children is also elusive, the causes behind the first cases of Type 2 are well recognised.

The latter, unheard of anywhere until 20 years ago, is attributed to a simultaneous increase in childhood obesity and inactivity. There are no registers for children suffering from Type 2, so there is a lack of clarity about the numbers developing the disease.

"Confirmed cases are in low double figures, but we don't believe this is a true reflection of the situation," says a spokesperson for Diabetes UK. "We are also assuming it will worsen: we appear to be following the USA pattern, where Type 2 diabetes in children is a significant cause for concern. The diagnosed cases are overweight, and social deprivation, expressed in a poor diet, seems to play its part."

In the UK, more Type 2 diabetes is recorded among Asians and African-Caribbeans, who tend to have a high-calorie diet.

So what of the new risks and threats in the headlines? HIVAids and TB are high on the list. Foreign travel and mobile populations make it impossible for any country to isolate itself from global diseases.

The number of children with HIVAids is reaching crisis point in many places. While the figures in the UK are still relatively low, there is no room for complacency.

TB still causes 2 million deaths a year around the world - 98 per cent in developing countries. Nowadays there are only around 7,000 cases per year in the UK, but the number has been increasing recently and the disease remains a real public health problem.

Parts of London with high levels of immigration, such as Brent, Ealing and Hackney, have the highest rates of TB in the country. In the capital, rates have risen by 80 per cent over 10 years.

With the rise in drug-resistant strains of the disease, experts warn that TB could also once again become a threat to Europe. Other "new threats" include severe acute respiratory syndrome (SARS) and new variant Creutzfeldt-Jakob Disease (nvCJD). Dr Julian Flowers, a consultant in Public Health Medicine at the Eastern Region Public Health Observatory, says reports of these need to be kept in perspective.

"Tthe threats posed by these diseases are also small," he says.

"Unfortunately, they are often given disproportionate weight. For example, in contrast with some of the predictions that have been made, deaths from nvCJD are actually on the decline. Similarly, the new super pneumonia appears alarming, but is occurring in very small numbers.

"Overall, people need to remember that the UK population is much healthier than it used to be and is getting healthier still."

Dr Harvey Marcovitch, consultant paediatrician at the Royal College of Paediatrics and Child Health, agrees. He points out that vaccinations could be introduced in the near future to reduce childhood illnesses further.

"It is already perfectly possible to prevent chicken pox," he says. "The problem lies in overcoming the anxieties of parents and gaining acceptance of vaccinations. That isn't the job of health professionals - it requires political action."

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